Barsky A J, Borus J F
Division of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Ann Intern Med. 1999 Jun 1;130(11):910-21. doi: 10.7326/0003-4819-130-11-199906010-00016.
The term functional somatic syndrome has been applied to several related syndromes characterized more by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient's belief that he or she has a serious disease. Four psychosocial factors propel this cycle of symptom amplification: the belief that one has a serious disease; the expectation that one's condition is likely to worsen; the "sick role," including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic syndromes includes sensationalized media coverage, profound suspicion of medical expertise and physicians, the mobilization of parties with a vested self-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fears and pessimistic expectations, prolong their disability, and reinforce their sick role. A six-step strategy for helping patients with functional somatic syndromes is presented here.
功能性躯体综合征这一术语已应用于几种相关综合征，这些综合征的特征更多地在于症状、痛苦和残疾，而非始终可证实的组织异常。这些综合征包括多重化学敏感性、病态建筑综合征、重复性应激损伤、硅胶乳房植入物的副作用、海湾战争综合征、慢性挥鞭伤、慢性疲劳综合征、肠易激综合征和纤维肌痛。患有功能性躯体综合征的患者有明确且详尽的自我诊断，其症状往往对安慰、解释和症状的标准治疗无反应。它们具有相似的现象学、高共病率、相似的流行病学特征以及高于预期的精神疾病共病患病率。尽管在一些功能性躯体综合征患者中最终可能会发现离散的病理生理原因，但这些患者的痛苦因一个自我延续、自我验证的循环而加剧，在这个循环中，常见的、地方性的躯体症状被错误地归因于严重异常，强化了患者认为自己患有严重疾病的信念。有四个社会心理因素推动了这种症状放大的循环：认为自己患有严重疾病的信念；认为自己的病情可能恶化的预期；“病人角色”，包括诉讼和赔偿的影响；以及将病情描述为灾难性和致残性的警示性描述。围绕功能性躯体综合征的氛围包括媒体的耸人听闻的报道、对医学专业知识和医生的深深怀疑、对功能性躯体综合征现状有既得利益的各方的动员、诉讼以及一种过度强调生物医学而忽视社会心理因素的临床方法。所有这些影响都加剧并使功能性躯体综合征患者的躯体痛苦长期存在，加剧了他们的恐惧和悲观预期，延长了他们的残疾时间，并强化了他们的病人角色。本文提出了一种帮助功能性躯体综合征患者的六步策略。
